Scrutinizing Stress

12-year-old Mia Troquille

Three years ago, Mia Troquille expected that getting into fourth grade would be her No. 1 challenge. Then she heard the words acute lymphoblastic leukemia.

“The day my cancer was diagnosed,” says Mia, now 12, “was the last day of the school test to determine if you passed. I finished the test, but I missed fourth grade.”

Mia and her family embarked on a previously unfathomable journey to St. Jude Children’s Research Hospital and to cancer remission. Her last day of treatment occurred in December 2013.

“I think we handled it like professionals,” says her mom, Christie Barnes. “She’s a really strong little girl. As horrible as it was going through, I don’t really think it’s going to affect her future.

“I don’t feel that she has post-traumatic stress.”

This remarkable resilience, often anecdotally noted in childhood cancer patients, was also found in a St. Jude study of stress and adjustment, published in the Journal of Clinical Oncology.

Challenging assumptions

Sean Phipps, PhD

Sean Phipps, PhD, St. Jude Psychology chair, and his colleagues recently showed that childhood cancer patients are no more likely than their healthy peers to develop post-traumatic stress disorder. In fact, young cancer patients reported that the cancer experience helped them develop greater empathy and grow closer to family and friends.

The study showed childhood cancer patients are no more likely than their healthy peers to develop post-traumatic stress disorder (PTSD).

A condition of persistent mental and emotional distress, PTSD can result from injury, terror, severe shock or a life-threatening illness. The disorder may cause flashbacks, detachment, sleep disturbance and other problems. In the past, investigators at other institutions identified PTSD as widespread, affecting 20 percent to 35 percent of childhood cancer patients.

Now Sean Phipps, PhD, St. Jude Psychology chair, and his colleagues are finding otherwise.

“We suggest that the problem of PTSD in childhood cancer is an example of a ‘perpetuated fallacy,’” reported Phipps in the study.

Surprising strength

As part of the research, Phipps and his colleagues talked with 255 St. Jude patients, as well as 101 of their healthy peers between the ages of 8 and 17. Part of a long-term project tracking patient adjustment, the study involved three interviews with each child.

The control group, Phipps says, is key: “How can you talk about elevated stress in children with cancer unless you talk with children who don’t have it?

“It’s an important design issue that we do not identify cancer as the event of interest. If you tell participants, ‘We’re studying you because you have cancer and are traumatized,’ you get a lot more symptoms reported.

“We try to be as neutral as we can to allow the participant to decide what they believe is their most stressful event,” Phipps adds. “In this study, children identified that event.”

Fifty-two percent of current patients identified cancer as the most stressful event in their lives. But only 23.8 percent of children who had passed the five-year mark after diagnosis identified cancer as their most traumatic event. Parent interviews suggest slightly, but not significantly, higher rates of PTSD in their children.

The study is intended to help guide and encourage, Phipps says. “It’s pretty impressive if you assess children in a clinic, and only half identify that cancer is their most traumatic event.”

Resilience is the rule

Scientists found that only 2.8 percent of cancer patients met criteria for lifetime PTSD diagnoses. Two of those seven cases were cancer related; others included a drive-by shooting, displacement by Hurricane Katrina, homelessness and unexpected family deaths.

Not only do children with cancer appear to be resilient, but they report benefits and psychological growth as a result of their cancer experiences. In fact, the survivors report closer social connections, a deeper empathy for others and a healthy perspective about their journeys. The young survivors seem to gain more benefit from the cancer experience than they do from other stressful events in their lives.

As for young Mia, her ordeal with cancer pales in comparison to an experience she had in 2011, when she battled a serious respiratory infection.

“I took my mask off for a second,” Mia says, “and I got a fungus in my nose.”

“It was pretty bad,” her mom concedes, noting Mia’s several nasal surgeries and time in ICU. “But now she’s fine.”

“The resilient outcome is the rule,” reports Phipps, who believes the St. Jude findings could apply to children treated at other institutions.

“It’s sort of a miraculous thing,” he says, “a testament to the human capacity to endure and thrive.”